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All health plans must cover some basic services to help prevent illnesses and maintain your health and well-being.
Examples of preventive care are screenings and immunizations
Many preventive health services are free
You may pay for preventive care benefits if you don’t follow the rules of your health plan — like seeing an out-of-network provider
Preventive care is the process of performing diagnostic testing, physical exams, and immunizations to find and resolve potential health problems before they get worse and lead to chronic disease. Some examples of preventive services are mammograms, colonoscopies, and vaccines. Most people go to their primary care doctor for preventative care.
The federal government lists 18 tests and services that are considered preventive care and must be covered by your health plan for free. However, in some situations and depending on your health coverage, the insurance company may charge you.
Under the Affordable Care Act, known as Obamacare, every health insurance plan must cover a set of basic services to help prevent illness and maintain your health and well-being. Whether you got your health insurance coverage from the marketplace or through an employer, all plans are required to provide these health benefits at no cost to the insured person.
You may need to meet certain qualifications for some preventive services to be covered. For example, in order for health insurance to cover a screening for colorectal cancer, you must be 50 to 75 years old. There may also be variability regarding how often you can get these benefits; a preventive screening might be covered every year or on an as-needed basis. You can read more in-depth about preventive care guidelines on healthcare.gov, but here is a list of specific preventive services that must be offered at no cost by health providers:
The following immunizations and vaccines are also covered:
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There are also services aimed at women's health, which are available to pregnant women, women who may become pregnant, and mothers to newborn children.
The following are preventive care services available for children (birth to age 18). Some screenings have further restrictions regarding age.
However, health insurance providers are still allowed to charge you in certain situations according to the terms of your health plan. Most importantly, you might pay for preventive services if you seek care from an out-of-network provider that isn’t covered by your health insurance. (It’s important to know what type of plan you have — the differences between HMO, PPO, EPO, POS plans, for example — and what providers are in your network.)
Similarly, if a preventive screening or test is processed by an out-of-network provider, you may be responsible for the costs. Ask your doctor beforehand to find out as much information as you can.
Another reason a preventative service might not be free is if it wasn’t the primary reason for seeing the doctor. For example, if you see your primary care doctor because of an illness (seeking diagnostic care) and end up getting an unrelated preventive screening or immunization, you’ll still need to pay your usual office visit copay. Likewise, if you go in for a preventive care service and end up needing a full appointment, you may need to pay for the full appointment. To avoid this, make sure your preventive care visit is separate from your primary care visit.
Health insurance and life insurance work together to offer financial protection.
Health insurance can pay your medical expenses. Life insurance keeps your loved ones whole after you die.
About the author
Elissa is a personal finance editor at Policygenius in New York City. She writes about estate planning, mortgages, and occasionally health insurance. In the past she has written about film and music.
Policygenius’ editorial content is not written by an insurance agent. It’s intended for informational purposes and should not be considered legal or financial advice. Consult a professional to learn what financial products are right for you.
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